Evaluation Tool of Children's Handwriting

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September 30, 2025

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Purpose

The Evaluation Tool of Children's Handwriting (ETCH) is designed to assess a child's handwriting legibility and speed. It also evaluates the child's ability to manage a pencil while performing typical classroom writing tasks.

Link to Instrument

Acronym ETCH

Area of Assessment

Activities & Participation
Bodily Functions

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$259.99

Cost Description

Cost for the ETCH kit (plus tax and shipping costs) that includes reproducible score sheets and response booklets, quick reference sheets, wall charts, task sheets, a scoring card, a 163-page Examiner's Manual detailing test administration and scoring procedures for legibility.

CDE Status

Not a CDE--last searched 9/30/2025

Pediatric and Congenital Conditions

The ETCH measures an individual's manuscript and cursive handwriting. It is a paper-based tool administered and scored by educators and allied health professionals.
The manuscript measure for students in grades 1 and 2 is called the ETCH-M, and it includes 6 tasks:
1) Alphabet writing: 26 lower-case letter items & 26 upper-case letter items
2) Numeral writing: 12 numeral items
3) Near-point copying: 5 word items & 18 letter items
4) Far-point copying: 5 word items & 18 letter items
5) Dictation: 2 word items, 10 letter items, & 5 numeral items
6) Sentence composition: variable depending on sentence chosen by child

ETCH-M Score Distribution:
A) Word: 0 to 12
B) Letters: 0 to 98
C) Numeral: 0 to 34
D) Totals: 0 to 144
E) Legibility distribution: 0 to 100% for word, letter, and numeral scores
The cursive measure for students in grades 3-6 is called the ETCH-C, and it includes 7 tasks:
1) Alphabet writing: 26 lower-case letter items & 26 upper-case letter items
2) Numeral writing: 20 numeral items
3) Near-point copying: 5 word items & 31 letter items
4) Fair-point copying: 7 word items & 29 letter items
5) Manuscript-to-cursive: 6 word items & 31 letter items
6) Dictation: 3 word items, 15 letter items, & 5 numeral items
7) Sentence composition: variable depending on sentence chosen by child
Score distribution for ETCH-C:
A) Word: 0 to 21
B) Letters: 0 to 158
C) Numeral: 0 to 25
D) Totals: 0 to 204
E) Legibility distribution: 0 to 100% for word, letter, and numeral scores
Handwriting is assessed based on:
? Alphabet writing
? Near-Point Copying
? Far-Point Copying
? Dictation
? Sentence Composition
? Pencil Grasp and Hand Dominance
Scores are based on:
? Legibility (%)
? Speed (letters/word per minute)
? Pencil Grasp and Handwriting Behaviors
Final Scores include:
? Legibility Score
? Writing Speed
? Qualitative Observations

Number of Items

Examiner's manual
Master response booklet
Master score sheets
Task sheets
Wall charts
Quick reference sheets
Scoring card
Table
Chair
Stopwatch
2 no. 2 pencils

15-30 minutes

Required Training

Reading an Article/Manual

Required Training Description

This tool must be administered by educators or allied health professionals. The administrator must use page 163 of the Examiner's Manual detailing test administration and scoring procedures for legibility. No degree is required.

Child

6 - 12

years

Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Sara Brumm, Jasmine Brown, and Jazmin Landa. Updated September 2025 by OT students Rachel Graves, COTA/L, Kylie Kester, COTA/L, Erica Samuels, COTA/L, and Andrea Terese, COTA/L and reviewed by Jessica Schmidt, OTD, OTR/L from Concordia University of Wisconsin.

Body Structure

Upper Extremity

ICF Domain

Activity

Measurement Domain

Motor
Cognition

Professional Association Recommendation

None found--last searched 9/30/2025

Considerations

The ETCH can be used with any child that is having handwriting challenges with the following diagnoses: mild developmental delays, learning disabilities, and mild neuromuscular impairments.

Children with "severe involvement of mental retardation, emotional disturbances, or cerebral palsy may not be appropriate candidates as handwriting may not be a feasible means of written communication" (Amundson, 1995).

ETCH can be used to gather descriptive information on writing skills from older clients. However, it should be noted that the content may not be age- or content-appropriate for clients over 12 years, 5 months.

It is essential to exercise caution when using normative scores and cut-off scores, as the studies may not accurately represent the population.

Minimally Clinically Important Difference (MCID)

Children in Grades 2 and 3 with Attention Deficit Hyperactivity Disorder: (Brossard-Racine, Mazer, Julien, & Majnemer, 2012; n = 26)

In the ETCH-M, clinicians should not consider a change in scores over time as clinically significant if that change corresponds to less? than 6.0% for total letter legibility and less than 10.0% for total word legibility.

Cut-Off Scores

Children Aged 7 to 9 Years in Grades 2 and 3 with Writing Dysfunction: ?(Diekema, Deitz, & Amundson, 1998; n = 31)

Cut-off scores of 75.0% for total word legibility and 76.0% for total letter legibility were found to provide excellent levels of accuracy

Children in Grades 2 and 3 with Attention Deficit Hyperactivity Disorder: ?(Brossard-Racine, Mazer, Julien, & Majnemer, 2012)

75% total word legibility and 76.0% total letter legibility on the ETCH-M are suggested as teh cut-off values to discriminate between children with handwriting legibility difficulties who should be seen in rehabilitation for evaluation and treatment from those who have no such difficulties.

Children in Grades 6 and 7 with and without Writing Difficulties: (Duff & Goyen, 2010, n = 48)

Cut-off score of 92 for total letter was determined to be the best to discriminate between case and control participants (sensitivity = .88 and specificity = .83).
Cut-off score of 85 for total word was determined the best to discriminate between case and control participants (sensitivity = .71 and specificity = .75).
Cut-off score of 95 for total numeral was determined the best to discriminate between case and control participants (sensitivity = .42 and specificity = .88).

Second Grade Students: (Long et al., 2019; n = 74; mean age (range) = 7.6 (7.08-8.92) years; Predominantly English speaking (94.6%, n = 70), right-handed (93.2%, n = 69), male (45.9%, n = 34), Female (54.1%, n = 40))

Cut off scores on ETCH-M based on teacher perception of handwriting legibility:

For total letter legibility: 77% or less (Sensitivity ~ 87%, specificity ~ 73%)
For total word legibility: 82% or less (sensitivity ~ 83%, specificity ~ 43%)

First Grade Students: (Feder et al., 2007; n = 69; mean age (SD) = 82 (3.6) months; age range = 75-88 months; attending regular classroom; English speaking; Canadian sample)

�� -1.5 SD identifies children with handwriting difficulties on ETCH-M

Normative Data

Second Grade Students: (Long et al., 2019)

ETCH-M total subscale means and standard deviations for total group and by sex:

All students (n = 74)

Total Word Legibility: 88.81% (SD: 11.13)
Total Letter Legibility: 84.30% (SD: 10.15)
Total Numeral Legibility: 89.2% (SD: 9.41)

Female (n = 40)

Total Word Legibility: 92.21% (SD: 10.58)
Total Letter Legibility: 87.73% (SD: 9.25)
Total Numeral Legibility: 91.74% (SD: 9.59)

Male (n = 34)

Total Word Legibility: 84.82% (SD: 10.55)
Total Letter Legibility: 80.26% (SD: 9.79)
Total Numeral Legibility: 86.32% (SD: 8.40)

First Grade Students: (Feder et al., 2007)

Performance of Children in Grade One on the Evaluation of Children��s Handwriting-Manuscript (ETCH-M) (n = 69)

ETCH-M Component	Mean (SD)	Median	Minimum-Maximum
Handwriting Task Legibility (%)
Word	67.8 (23.3)	68.7	0-100.0
Letter	77.4 (13.7)	80.0	38.8-94.7
Numeral	86.9 (16.0)	94.1	23.5-100.0
Speed
Lowercase alphabet writing (seconds)	131.1 (55.2)	113.0	38.0-283.0
Uppercase alphabet writing (seconds)	144.0 (61.6)	126.0	44.0-377.0
Numeral writing (seconds)	37.5 (16.8)	33.0	17.0-100.0
Near-point copying (letters/minute)	21.5 (8.3)	21.7	8.7-47.4
Far-point copying (letters/minute)	17.1 (6.3)	17.0	0-34.0
Sentence composition (letters/minute)	20.7 (10.9)	21.3	0-41.8

Test/Retest Reliability

ETCH-Manuscript

First and Second Grade Students: (Diekema, Deitz, & Amundson, 1998)

Total/Task	Reliability Coefficient (ICC/Spearman Rank Order Correlation Coefficient)	Strength of ICC
Total Letter, Excluding VI	.11/1.00
Total Letter	.00/1.00
Total Numeral	.71^a	Adequate
Total Word	.77^b	Excellent
Total Word, Excluding VI	.63^a	Adequate
Ia. Alphabet Lowercase	.64^a	Adequate
Ib. Alphabet Uppercase	.76^b	Excellent
II. Numerals	.63^a	Adequate
III. Near-point Copying	.20^a	Poor
IV. Far-point Copying	.63^a	Adequate
V. Dictation	.68^a	Adequate
VI. Sentence Composition	.33^a	Poor

Notes: ^aSpearman rank order correlation coefficient; ^bIntraclass correlation coefficient

"Total legibility percentage scores were more reliable than individual task scores, so the researchers recommended that the therapists use total legibility percentage scores when evaluating progress and making intervention decisions" (Koziatek & Powell, 2002).

Interrater/Intrarater Reliability

ETCH-Manuscript

Children from Grades 1, 2, and 3 Receiving Occupational Therapy or Had Been Referred for Occupational Therapy Services: (Amundson, 1995)

Total/Task	Pearson^a	Pearson^b	ICC	Strength of ICC
Total Letters	.92	.90	.84	Excellent
Total Numbers	.85	.87	.82	Excellent
Total Words	.85	.75	.48	Adequate
Ia. Lower-case Letters	.87	.85	.68	Adequate
Ib. Upper-case Letters	.92	.91	.88	Excellent
II. Numerals	.76	.78	.70	Adequate
III. Near-point Copying (Letters)	.80	.76	.51	Adequate
III. Near-point Copying (Words)	.91	.71	.55	Adequate
IV. Far-point Copying (Letters)	.64	.74	.47	Adequate
IV. Far-point Copying (Words)	.76	.77	.58	Adequate
V. Dictation (Letters)	.90	.86	.79	Excellent
V. Dictation (Units)	.88	.69	.69	Excellent
VI. Sentence Composition (Letters)	.94	.85	.86	Excellent
VI. Sentence Composition (Words)	.80	.63	.42	Adequate

Notes: ^aSpearman rank order correlation coefficient; ^bIntraclass correlation coefficient.

ETCH-Cursive

Children from Grades 4, 5, and 6 Receiving Occupational Therapy or Had Been Referred for Occupational Therapy Services: (Amundson, 1995)

Total/Task	Pearson^a	Pearson^b	ICC	Strength of ICC
Total Letters	.97	.97	.89	Excellent
Total Numbers	.53	.70	.53	Adequate
Total Words	.90	.98	.94	Excellent
Ia. Lower-case Letters	.90	.90	.86	Excellent
Ib. Upper-case Letters	.97	.96	.86	Excellent
II. Numerals	.77	.86	.53	Adequate
III. Near-point Copying (Letters)	.91	.91	.77	Excellent
III. Near-point Copying (Words)	.76	.77	.49	Adequate
IV. Far-point Copying (Letters)	.94	.93	.91	Excellent
IV. Far-point Copying (Words)	.75	.64	.34	Poor
V. Manuscript-to-Cursive (Letters)	.94	.94	.92	Excellent
V. Manuscript-to-Cursive (Words)	.78	.75	.57	Adequate
VI. Dictation (Letters)	.94	.96	.94	Excellent
VI. Dictation (Units)	.74	.81	.62	Adequate
VII. Sentence Composition (Words)	.93	.96	.88	Excellent
VII. Sentence Composition (Letters)	.95	.88	.74	Adequate

Notes: ^aSpearman rank order correlation coefficient; ^bIntraclass correlation coefficient.

First and Second Grade Students: (Feder & Majnemer, 2003; sample not reported; ETCH-M)

Excellent interrater reliability between an experienced and inexperienced rater, Average: (ICC = 0.79)
Excellent interrater reliability between two experienced raters, average: (ICC = 0.84)
Adequate intraclass correlation coefficients average: (ICC = 0.66)
Adequate interrater reliability for sentence composition task between experienced and inexperienced raters: (ICC = 0.42)
Adequate interrater reliability for word legibility of individual tasks: (ICC = 0.42-0.58)

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Second Grade Students: (Long et al., 2019)

Adequate predictive validity for ETCH-M total letter legibility on predicting teachers�� perceptions of letter legibility (R² = 0.46)

Concurrent validity:

Children in Grade 4: (Koziatek & Powell, 2002; n = 101, ETCH-C)

Variable	Validity Coefficients of Teachers Grades for Worksheets	Strength of Validity Coefficients
ETCH-C Words	.61	Adequate
ETCH-C Letters	.65	Adequate
Worksheet Words	.76	Excellent
Worksheet Letters	.78	Excellent

Construct Validity

Convergent validity:

First Grade Students:(Feder et al., 2007)

Adequate correlation between teacher ratings of handwriting and ETCH-M scores (r = 0.40-0.45).
Adequate correlations (all p �� 0.05) between the Visual Motor Control subtest of the Bruininks-Oseretsky Test of Motor Proficiency Fine Motor (BOTMP FM) and the Word Legibility (r = 0.36), Letter Legibility (r = 0.35), and Number Legibility (r = 0.40) subtests of the Evaluation Tool of Children's Handwriting-Manuscript (ETCH-M)

Discriminative validity:

Children in Grades 6 and 7 with and without Writing Difficulties: (Duff & Goyen, 2010; n = 48; ETCH-C)

Total Letter ROC curve indicates adequate discriminant validity (area under the curve = .86; 95% confidence interval [CI] = (.75, .98)
Total Word ROC curve indicates adequate discriminant validity (area under the curve = .85; 95% CI = (.47, .96)
Total Letter ROC curve indicates adequate discriminant validity (area under the curve = .76; 95% CI = (.63, .90)

Content Validity

Three pilot editions of the ETCH-M were carried out, followed by test revisions. Each phase involved a different panel of experts (occupational therapists, regular and special educators, and physical therapists (Feder & Majnemer, 2003, p. 79)

Bibliography

Amundson, S. (1995). Evaluation Tool of Children's Handwriting. Homer, AL: OT KIDS.

Brossard-Racine, M., Mazer, B., Julien, M., & Majnemer, A. (2012). Validating the use of the Evaluation Tool of Children's Handwriting-Manuscript to identify handwriting difficulties and detect change in school-age children. American Journal of Occupational Therapy, 66(4), 414-421.

Diekema, S.M., Deitz, J., & Amundson, S.J. (1998). Test-retest reliability of the Evaluation Tool of Children's Handwriting-Manuscript. American Journal of Occupational Therapy, 52(4), 248-255.

Duff, S. & Goyen, T.A. (2010). Reliability and validity of the Evaluation Tool of Children's Handwriting-Cursive using the general scoring criteria. American Journal of Occupational Therapy, 64(1), 37-46.

Feder, K.P. & Majnemer, A. (2003). Children's Handwriting Evaluation Tools and their psychometric properties. Physical & Occupational Therapy in Pediatrics, 23(3), 65-84.

Feder, K.P., Majnemer, A., Bourbonnais, D., Blayney, M., & Morin, I. (2007). Handwriting performance on the ETCH-M of students in a grade one regular education program. Physical & Occupational Therapy in Pediatrics, 27(2), 43-62.

Koziatek, S.M. & Powell, N.J. (2002). A validity study of the Evaluation Tool of Children's Handwriting-Cursive. American Journal of Occupational Therapy, 56(4), 446-453.

Long, D.M. & Conklin, J. (2019). Handwriting performance of typical second-grade students as measured by the Evaluation Tool of Children's Handwriting-Manuscript and teacher perceptions of legibility. The Open Journal of Occupational Therapy, 7(4), 1-14.

Sudsawad, P., Trombly, C.A., Henderson, A., & Tickle-Degnen, L. (2001). The relationship between the Evaluation Tool of Children's Handwriting and teachers' perceptions of handwriting legibility. American Journal of Occupational Therapy 55(5), 518-523.

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